Prolonged survival by 'early' salvage treatment of breast cancer patients: a retrospective 6-year study

Abstract

Summary Between 1977 and1993, 384 breast cancer patients were followed up post-operatively every 4 or 6 months with a serum tumour marker panel (CEA-TPA-CA1 5-3) and the usual imaging techniques. Twenty-eight patients were treated 13.5±10 months (mean±s.d.) before the clinical and/or radiological occurrence of distant metastases that were suspected because of an increase in the tumour markers (patients treated 'early'). Their outcome was compared with that of 22 similar patients who were treated only after a definite radiological diagnosis was achieved (patients treated 'not early'). The median survivals from mastectomy and salvage treatment were also compared for the two groups. The groups were similar for all the major prognostic factors (menopause, staging, hormone dependency). In the group treated 'early', the lead time from the tumour marker increase to the clinical and radiological signs of metastases was significantly longer than that of the group not treated 'early' (13.5 ± 10 vs 3.4 ± 2.8 months respectively; P < 0.001 by unpaired t-test). For patients treated 'early', the survival curves up to 30 months after salvage treatment and up to 72 months after mastectomy showed greater survival than those for the patients treated later (42.9% vs 13.6% and 42.9% vs 22.7% respectively; P = 0.04 in both instances). These data suggest that treatment triggered by rising tumour markers before clinical and/or radiological appearance of distant metastases can be useful in prolonging both the asymptomatic interval and the duration of response of some relapsed patients. Randomized prospective trials must be encouraged to confirm these data and to better evaluate the effect on the disease-free survival (DFS) and overall survival (OS) of 'early' salvage treatment protocols.

Postoperative Follow-Up of Breast Cancer Patients: Overview and Progress in the Use of Tumor Markers

“…We found that in some untreated patients CEA, TPA and CA15.3 anticipated by 2.7-5.1 months the clinical-instrumental signs of distant metastases [28,37,47] according to other authors' data [13]. Table 5 shows the various kinds of tumor marker Table 5.…”

“…Twenty-eight patients treated before the clinical and/or radiological detection of distant metastases because of an increase in tumor markers suggesting relapse (patients treated 'early') were compared with 22 patients similar in all major prognostic factors who were treated only after a definite radiological diagnosis was obtained (patients treated 'not early'). For patients treated 'early' the survival curves up to 30 months after salvage treatment and up to 72 months after mastectomy showed a superior survival to that of patients treated later (p = 0.04 in both instances) [47]. Further work is in progress.…”

“…Thus, tumor markers can decrease to a large extent the number of patients to be examined with radiological means [48]. As yet no follow-up study except for our previously published one [47] showed a significant impact on overall survival and diseasefree survival by treating metastases following an earlier detection with serum tumor markers. In the two prospective randomized trials by Rosselli del Turco et al [12] and by the GIVIO Investigators [11], the use of the common serum tumor markers was not considered.…”

Serum tumor markers and PET/CT imaging for tumor recurrence detection

“…Accordingly, many centres world-wide perform serial CA15-3 measurements in the routine followup of these patients as for some women it provides the earliest evidence of recurrent disease, for which mul-tiple forms of treatment are available, and intuitively it might be hoped that the earlier treatment is initiated, the better the outcome. Firm evidence demonstrating that early initiation of treatment based on this lead-time improves patient outcome or quality of life is lacking although a small number of papers do suggest a benefit in outcome adopting this approach [20][21][22].…”

Tumour Markers and Molecular Imaging with FDG PET/CT in Breast Cancer: Their Combination for Improving the Prediction of Disease Relapse

“…After an average follow-up of 11 months, 7 out of 29 patients (24%) in the control group had relapsed, whereas none of the 23 patients who had received treatment developed a recurrence (p= 0.012). Nicolini et al (Nicolini et al, 1997; compared the outcomes in 36 asymptomatic patients who received salvage treatment based on tumour marker increases (CA 15-3, CEA, or TPA) with 32 patients who were given treatment only after radiologic confirmation of metastasis. Survival from both the time of mastectomy and salvage treatment was significantly improved in the group with tumour marker-guided treatment than in those treated conservatively.…”